A B S T R A C TBackground: Cardiovascular autonomic diabetic neuropathy (CADN) is an important diabetes-associated complication. Reduced heart rate variation is the earliest indicator of CADN. Aims: The aim was to study the prospect of using short term heart rate variability (HRV) analysis for early diagnosis of CADN. Settings and Design: The type of this study was hospital-based comparative cross-sectional study. Materials and Methods: A total of 30 asymptomatic, type 2 diabetic male patients with duration of diabetes of 1-5 years with random blood sugar ≥200 mg/dl (11.1 mmol/L) or fasting blood sugar ≥126 mg/dl (7 mmol/L) in the age group of 30-65 years were selected as subjects. Thirty age and sex matched healthy nondiabetics were selected as controls. HRV analysis was performed using electrocardiogram recorded in lead II, at rest, in the supine position for 5 min. Results: Total power, low frequency power, high frequency power, standard deviation of all R-R intervals, root mean square of successive RR-interval differences, number of intervals differing by >50 ms from adjacent interval (NN50), and percentage of NN50 (pNN50) were signifi cantly less in diabetics when compared to nondiabetics (P < 0.05). Conclusion: Data from the study demonstrated that asymptomatic diabetics with <5 years history had already developed autonomic neuropathy. Short term analysis of HRV can be used as a valuable tool for early diagnosis of autonomic neuropathy.

Introduction: Even though Mortality and Morbidity meetings (M&Ms) are incorporated into postgraduate training programs for imparting the attributes of self-appraisal, audit and quality control, they are not uniformly structured across institutes. This study describes the pattern of conducting M&M at a Medical College in North Karnataka in the context of the perceptions of faculty and residents of our medical college and proposes recommendations. Aim: To generate recommendations for conducting structured M&Ms meetings derived from the perceptions of faculty and residents, and prior feasibility experience at a medical college hospital. Materials and Methods: The present mixed method study was conducted in the Department of General medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India, in the month of July 2022. The perceptions of faculty and residents of medicine were obtained by a paper survey. The results of the survey were compiled and analysed by the one of the authors. The responses were matched with the records of M&Ms as conducted in the Department of General Medicine from November 2017 to May 2019. The cases were thematically analysed as deviation from standard protocols of care, multidisciplinary consults, iatrogenic cause of death, unresolved diagnosis and system failure by other authors. Any recommendations recorded were noted. The attendance for such meetings were measured as a surrogate of importance attached. Data was entered in the Microsoft Excel spread sheet. Descriptive statistics were calculated by frequency and proportions for qualitative variables. Results: A total number of 150 participants (65 were faculty including senior residents and the remaining 85 were postgraduate residents) completed the survey. The participants of the survey preferred the presentation by 3rd year residents and junior faculty. While selecting the cases for M&Ms, they preferred systematic selection turn-wise. The participants of the survey considered that while analysing M&M cases; conflicts in multidisciplinary consults, iatrogenic cause of death, human error and deviation from standard protocols of care should be emphasised. During November 2017 to May 2019, a total of 38 M&Ms were held (19 mortality and 19 morbidity meetings). The criterion for mortality case selection was subjective. Five cases were presented during each meeting. Predominant case presentations included interdepartmental transfer issues and procedural lapses. The Department of General Medicine had 30 postgraduate residents and 25 faculty members. The average attendance of residents and faculty was 90% and 78%, respectively. Conclusion: Regularly conducted M&M in a medical college hospital are important in training medical students for audit of medical errors, quality control and appraisal in a safe environment. Prospective selection of cases by recognising potential incidents; and evidence based, structured, uniform conduct of M&Ms by participation of teams involved in healthcare can reduce errors.

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Background: Malaria is one of the common causes of acute febrile illness in tropical countries. Malaria presents with varied manifestations. This retrospective study carried to know the clinical profile and laboratory abnormalities seen in malaria patients.Methods: The data was collected retrospectively from 1st January to 31st December 2017. Inclusion criteria: all fever cases above 15 years of age of both the sexes diagnosed as malaria by peripheral smear examination and malaria card test. Exclusion criteria: combined malaria with other fevers such as dengue, chikangunya. Fever cases negative for malaria tests. Malaria cases with history of chronic kidney disease, chronic liver disease such as cirrhosis of liver, chronic viral hepatitis, liver abscess, and chronic illness such as rheumatoid arthritis, diabetes, and hypertension. The data regarding the clinical presentation of patients and laboratory values such as hemoglobin, total leukocytecount, platelet count, total bilirubin, SGOT, SGPT, albumin values collected and analyzed with tables and percentage.Results: A total of 57 malaria cases were analyzed, 71.9 % males, 28.1% were females. The commonest age group was between 15- 30 years (61.4%). 29 patients (50.9%) had P. vivax, 20 patients (35.1%) P. falciparum and 8 patients (14%) mixed infection. The most common clinical presentation was fever with chills (100%) followed by vomiting (68.4%), splenomegaly (56.1%), headache (45.6%), pain abdomen (43.9%).19 cases (33.3%)  had hemoglobin less than 10gm/dl; 42 cases (73.6%) had thrombocytopenia; 46 cases (80.7%) had urea ≥30mg/dl; 14 cases (24.6%) had creatinine ≥1.4; 26 cases (45.6%) had total bilirubin >1.2mg/dl ; 17 cases (29.8%) had SGOT >45 IU; 33 cases (57.9%) had SGPT > 45 IU and 32 cases (56.1%) had albumin level ≤3.5gm/dl.Conclusions: In the study malaria due to P. vivax was more common than P. falciparum, malaria affected young adults, males more than females. Reduced hemoglobin and platelet count, deranged liver and renal function and reduced serum albumin seen commonly in malaria.